BPH (Enlarged Prostate)

Some or all of the following symptoms may occur with BPH:

• Difficulty starting your urinary stream
• Weaker urine stream
• Inability to completely empty the bladder
• Straining to urinate
• Waking up at night to urinate
• Sudden urge to urinate
• Urinating more often
• Urine leakage

Your prostate may become larger as you age, often beginning in your 40s – 50s, sometimes earlier. The condition, called BPH, is non-cancerous and is very common, affecting the majority of men over age 60. But it’s important to have BPH treated because the enlargement tends to block the urethra and urine flow out of the body. Without treatment, damage to the bladder and an eventual loss of bladder function can occur.

Although commonly related to an enlarged prostate in men, symptoms can also be due to urinary tract infections, bladder or kidney stones, urethral stricture/scar tissue formation, inflammation of the prostate (prostatitis), problem with the nerves to the bladder, or a cancer of the bladder or prostate. That’s why it’s important to see your urologist if you experience these symptoms.

During your visit to Colorado Springs Urological Associates, your doctor will ask about your medical history and will examine your abdomen and genitalia. You may be asked to complete a short survey regarding how you urinate.

Tests that may be performed during or after your visit:

• Digital rectal exam: The size of your prostate, and any possible abnormalities, are determined as your physician inserts a finger into your rectum.
  Urinalysis: A urine test evaluates for blood in the urine or infection.
• Cystoscopy:LINK to Treatment/Cystoscopy This is a procedure performed in the office where the physician inserts a small scope into the penis to assess the urethra for any scar tissue and evaluate the prostate for any evidence of obstruction.
• Prostate ultrasound: A probe is inserted into the rectum to check the size and shape of the prostate.
• Blood test: A blood test called a PSA (prostate-specific antigen) test will help determine your risk of prostate cancer.
• Post-void residual: You are asked to urinate. Then you are checked to see how completely you are emptying your bladder.
• Urine flow: You urinate in a funnel to assess the speed of your urinary stream.
• Urodynamics: [LINK to Treatments/Urodynamics] A small tube is inserted into the penis and another into the rectum to help measure the pressures in the bladder during filling and urination.
• Urocuff test: An easy, in-office test to measure urine flow and pressure with the use of a small device at the tip of the penis.

We offer a variety of BPH treatments to put you at ease and help protect your bladder and your kidneys. BPH is among the leading reasons men visit the urologists at Spokane Urology, and why we are dedicated to offering the most advanced treatments to suit a range of needs.

Medications and Lifestyle Modifications

• Lifestyle modifications: The most conservative course of action is best to try first, unless circumstances warrant a more aggressive approach. These simple steps may include changing bathroom habits and dietary changes.
• Alpha blockers: Medication to relax the prostatic urethra and bladder neck, making urination less difficult. Most common are tamsulosin (Flomax), silodosin (Rapaflo), and alfuzosin (Uroxatral).
• 5-alpha reductase inhibitors: Medication to shrink the prostate (takes 4-6 months to start working). Most common are finasteride (Proscar) and Dutasteride (Avodart).
• Tadalafil (Cialis): Improves quality of life related to urination and is used to treat erectile dysfunction.

Minimally Invasive Treatments

• Aquablation Therapy: [INSERT LINK Specialized Treatments > BPH > Aquablation] Using robotic technology, the surgeon uses a heat-free water jet to trim enlarged prostate tissue. This procedure requires anesthesia and may require an overnight hospital stay.
• iTind™: A small, collapsed device is placed in your urethra. The device gently expands over 5-7 days, creating a wider opening to allow urine to flow freely. The device is removed after 7 days.
• Prostate Artery Embolization (PAE): [INSERT LINK Specialized Treatments >BPH > PAE]] Prostate artery embolization, or PAE, is a non-surgical procedure that can improve lower urinary tract symptoms by blocking the blood flow to the prostate, thereby reducing the size of the prostate. PAE is a revolutionary treatment provided by Inland Imaging, our partner in interventional radiology.
• Rezum: LINK to Treatment/Rezum A treatment that uses the natural energy stored in water vapor, or steam, to remove excess prostate tissue that is compressing the urethra. A catheter may be required for a short time after the procedure.
• UroLift®: [INSERT LINK Specialized Treatment > BPH > UroLift] This incision-free procedure involves retracting, not removing, the tissue that blocks the urethra. The surgeon inserts small implants into each side of the prostate, pulling the walls of the prostate away from the urethra and opening the channel.

Surgical Treatments

• Transurethral Incision of the Prostate (TUIP): This procedure involves a precise pair of incisions being made in the bladder neck where the prostate merges with the bladder. This will release the restriction of the bladder-outlet and improve symptoms of BPH.
• Transurethral Resection of the Prostate (TURP): LINK to Treatment/TURP This remains the gold standard of treatment against which all other options are compared. During the procedure, the physician gently threads a thin instrument called a resectoscope through the urethra and into the prostate. The resectoscope, equipped with a camera, delivers electric currents to trim away obstructing tissue.
• Open Simple Prostatectomy: Simple prostate removal, or prostatectomy, is a procedure to remove the inside part of the prostate gland to treat an enlarged prostate. It is done through a surgical incision and generally requires a 2- to 4-day hospital stay, 6-8 weeks recovery.
• Robotic Simple Prostatectomy: LINK to Treatments/Robotic Simple Prostatectomy for BPH This is enucleation (keeping the capsule intact) of the prostate. It is done laparoscopically through small incisions in the abdomen. This is a safer technique with less pain postoperatively due to better visualization and controlled removal of the adenoma compared to open simple prostatectomy. This is a very definitive and usually permanent solution for very large prostates. It requires an overnight stay in the hospital and a catheter for about one It is often recommended for prostate glands larger than 100 cc in volume.